Alphabetical List of Forms and Publications
The forms and
publications in this section are available from the Wisconsin Department of
Health Services (DHS), US Environmental Protection Agency
(EPA), or US Department of Housing and Urban Development (HUD). DHS
forms may either be downloaded and printed through the
provided links or the EPA publications may either be downloaded and printed through the
provided link or ordered through the National
Lead Information Center Document Request Form.
The Advantages of Becoming a Lead-Safe
Company (PPH 44048, PDF, 62 KB)
This brochure explains the benefits for Wisconsin
contractors to become certified as lead-safe companies.
Application
for Registration of Lead-Free or Lead-Safe Property (DPH
44011, PDF, 48 KB)
Lead investigators performing a lead-free inspection
or lead-safe investigation can use this form to apply for
registration of a property.
Blood
Lead Lab Reporting ( F-00017, PDF, 101 KB) Health care
providers and laboratories can use this form to report blood lead test
results of Wisconsin residents. This form is also available
in Microsoft Word
Fillable format.
Certification
Application - Company (F-00171, PDF,
16 KB)
Complete this form to apply for certification of a lead
company. This can also be completed for renewal of
certification.
Certification
Application - Individual (F-44003, PDF,
36 KB)
Complete this form to apply for to become certified
to do lead hazard investigations or reduction work. This can also be completed for renewal of
certification.
"Contractors/Painters/Home
Remodelers: Look Out for Lead" (PPH 4529, PDF,
294 KB) (Wisconsin Division of Public Health) A
tri-fold pamphlet for contractors providing basic information to consider
before starting a remodeling job, such as using lead-safe work practices
and notifying families with young children about how to protect their
family from lead hazards in the home.
Coping
With Your Child's Diagnosis (PDF,
590 KB)
(Exit DHS)
A booklet for parents/caregivers acknowledging the emotions experienced
when told a child has been lead poisoned.
Fact
Sheet: EPA and HUD Move to Protect Children from
Lead-Based Paint Poisoning; Disclosure of Lead-Based
Paint Hazards in Housing (PDF,
31 KB)
(Exit DHS - Department of Housing and Urban Development)
Help
Yourself to a Healthy Home (PDF,
1.3 MB)
(Exit DHS - Department of Housing and Urban
Development) A self-help booklet for
parents/caregivers that covers housing-related health issues such as
asthma, lead, etc.
Lead Abatement Worker, General Supervision
Qualification Affidavit (F 44015, PDF,
12 KB)
A lead company must complete this form before a
lead abatement worker performs enclosure or
encapsulation abatement activities under general supervision.
Lead In Your
Home: A Parent's Reference Guide (PDF,
362 KB)
(Exit DHS - Environmental
Protection Agency) A 70-page illustration book with
information on lead poisoning prevention for parents of
young children living in a pre-1978 home with lead-based paint.
Lead Paint Safety: A Field Guide
for Painting, Home Maintenance, and Renovation Work in English
(PDF, 1.3 MB) and
Spanish
(PDF, 1.9 MB)
(Exit DHS -
Department of Housing and Urban Development) A step-by-step manual that
illustrates the safety precautions to take when painting, doing
maintenance or renovating in homes built before 1978.
Lead-Based
Paint Investigation Summary Report (F
44013, PDF, 15 KB)
Lead investigation companies must complete this
form or file lead investigation reports on the
internet through WALDO.
NOTE: This form is fillable and can be printed,
but cannot be saved.
The
Lead-based Paint Pre-Renovation Education Rule
(PDF, 362 KB)
(Exit DHS - Environmental
Protection Agency) This handbook for contractors,
property managers, and maintenance personnel describes the requirements
that apply when more than 2 square feet of lead-based paint is
disturbed.
Lead-Free
Inspection Affidavit of Property Owner (F
44014, PDF, 11 KB)
Lead Investigators performing a lead-free inspection
must have this completed form or a clearance report on file.
Lead-Free
/ Lead-Safe Property Registry, Training Course, Class and
Roster Database Access Application (F
44010, PDF,12 KB)
Lead Investigators, contractors, and training
providers requesting access to the Wisconsin Asbestos Lead
Database Online must complete this application.
Living
in Registered Lead-Safe Property (PPH
44042)
Important information for tenants living in a registered lead-safe
property.
"Look Out for Lead: Where to Look" - coloring sheet - in
English & Spanish (PDF, 869
KB)
An activity sheet which identifies places in the home and yard where
lead hazards can be found.
Notification of
Lead-Based Paint Activity (F 44012,
PDF, 26 KB)
Lead supervisors must complete and submit this
form before lead work takes place.
Nursing
Case Management Report (DPH 4771A, PDF, 34KB)
Nursing Case
Management Report - (Word Fillable)
This form is used for case management of children with elevated blood lead
levels.
Nursing
Case Closure Report (DPH 4771B, PDF, 26KB
)
Nursing Case
Closure Report - (Word Fillable)
This form is used for case management of children with elevated blood lead
levels.
Occupant Protection
Plan (F 44016, PDF, 26 KB)
The lead company must complete and submit this form
before lead work takes place, in
accordance with form instructions.
"Parents: Look Out for Lead" in
English
& Spanish
(PPH
4535, PDF, 92 KB) (Wisconsin Division of Public Health) A
tri-fold pamphlet for parents and caregivers providing
basic information about blood lead testing, where to
look for lead hazards and what to do about them.
Property
Investigation Report (DPH 4771C, PDF, 46KB )
Property
Investigation Report - (Word Fillable)
This form is used for property investigation of properties with children
with elevated blood lead levels.
Property
Investigation Closure Report (DPH 4771D. PDF, 24KB
)
Property
Investigation Closure Report - (Word
Fillable)
This form is used for property investigation of properties with children
with elevated blood lead levels.
"Protect Your Family From Lead" in English,
Spanish, and Vietnamese
Russian, and
Arabic
(Exit DHS - Environmental
Protection Agency) Owners of pre-1978 housing are required
to give this to tenants when entering into or renewing a rental
agreement or before more than 2 square feet of lead-based paint
is disturbed.
Reducing
Lead Hazards When Remodeling Your Home (PDF,
933 KB)
(Exit DHS - Environmental
Protection Agency) When remodeling or renovating
your pre-1978 home, this pamphlet explains how to reduce
exposure from lead-based paint.
"Rental
Property Owners: Look Out for Lead" (PPH
4535B, PDF, 334 KB) (Wisconsin Division of Public Health)A
tri-fold pamphlet for rental property owners who own properties built
before 1978 that may contain lead hazard and may be occupied by families
with young children. Includes information on what can be done to correct
lead hazards and about the law to notify tenants about lead hazards and
how to prevent exposure to lead.
Request
for Repairs (DPH 44018, PDF, 20
KB)
This form is to be given to tenants by the property owner of registered lead-safe
property before repairs commence.
Testing
Your Home for Lead (PDF,
204 KB)
(Exit DHS - Environmental
Protection Agency) This booklet explains the
process of testing your home for lead-based paint,
including the lead
investigator's role.
Visual
Inspection of Registered Lead-Safe Property (F
44005, PDF, 11 KB)
Property owners of a registered lead-safe property are
to complete this form annually, to maintain certification.
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Page - Lead-Safe Wisconsin Last Revised:
May 10, 2012
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